Provider Demographics
NPI:1831526235
Name:MORAN, MARIA CHANG (DDS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CHANG
Last Name:MORAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 IRON GATE CT
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9677
Mailing Address - Country:US
Mailing Address - Phone:804-519-4147
Mailing Address - Fax:
Practice Address - Street 1:10104 FORD AVE
Practice Address - Street 2:SUITE G
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-8850
Practice Address - Country:US
Practice Address - Phone:912-445-5337
Practice Address - Fax:888-289-4301
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.8297 GD1223G0001X
VA04014136041223G0001X
GADN0148741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice